Provider Demographics
NPI:1750159778
Name:WILLOW GROVE THERAPY LLC
Entity type:Organization
Organization Name:WILLOW GROVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHMIELEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, PMH-C
Authorized Official - Phone:443-356-6165
Mailing Address - Street 1:808 REGESTER AVE
Mailing Address - Street 2:
Mailing Address - City:IDLEWYLDE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1345
Mailing Address - Country:US
Mailing Address - Phone:443-356-6165
Mailing Address - Fax:
Practice Address - Street 1:808 REGESTER AVE
Practice Address - Street 2:
Practice Address - City:IDLEWYLDE
Practice Address - State:MD
Practice Address - Zip Code:21239-1345
Practice Address - Country:US
Practice Address - Phone:443-356-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health